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Pigmented Flashcards

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Dermatology Board Prep flashcards
1
Q

CARP pathophysiology

A
  • abnormal host reaction to Malasezzia, although only isolated in 50% of cases resulting in abnormal keratinocyte differentiation
  • responds to tetracyclines –> ? antibiotic or anti-inflammatory
  • Associated with: obesity, insulin resistance, thyroid dysfunction and Cushing disease
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2
Q

CARP Histology

A
  • Hyperkeratosis and papillomatosis, loss of granular layer

- Increased melanin in the basal cell layer and stratum corneum

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3
Q

CARP Clinical

A

1-2 mm hyperkeratotic papules on the turnk that coalesce and form greyish-blue plaques, confluent in centre and reticular on periphery

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4
Q

DDx for CARP

A
  • AN
  • Macular amyloid
  • Darier
  • Epidermal naevus
  • Planar warts
  • Pit versicolor
  • Seb k
  • Retention hyperkeratosis
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5
Q

CARP Management

A
  • no treatment if no cosmetic bother
  • weight reduction/remove offending agent
  • First line: minocycline appears to be most beneficial
  • Second: topical and systemic antifungals
  • Third: low dose isotretinoin
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6
Q

Ephiledes epidemiology and pathogenesis

A
  • More common in blondes and red heads
  • Sun induced melanogenesis and transport of an increased number of fully melanised mealnosomes from melanocytes to keratinocytes
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7
Q

Ephelides clinical

A
  • Sun exopsed areas
  • 1-3 mm in diameter - round, oval or irregular in shape
  • Marker of UV induced damage
  • High freckle density –> high risk of melanoma
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8
Q

Ephelides histo

A
  • Keratinocytes have increased melanin content

- Occasionally, melanophages in papillary dermis

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9
Q

Ephelides ddx

A
  • Simple lentigines
  • Solar lentigines
  • CALMs
  • Junctional naevi
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10
Q

Ephelides treatment

A
  • Photoprotection
  • Lighten: topical retinoids and hydroquinone
  • Broadband light therapy
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11
Q

CALMS pathogenesis

A
  • Increased melanogenesis and increased melanin content in keratinocytes
  • Biallelic NF1 inactivation has been identified in melanocytes from CALMs in patients with NF1 and McCune Allbright
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12
Q

CALMS clinical

A
  • Light brown macule, can be anywhere except mucous membrane
  • Usually 2-5 cm
  • Dermoscopy: homogenous brown patch, with perifollicular hypopigmentation
  • Unilateral
  • Associations:
    • NF
    • McCune Albright
      • Triad of macular patches, bony lesions and endo (overactive hormones)
      • GNAS gene mutation
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13
Q

CALMS histology

A
  • Slightly increased melanin content in basilar keratinocytes
  • Adnexal epithelium spared of hyperpigmentation
  • DOPA stained: density of melanocytes higher in both CALMS and normal adjacent skin
  • Melanin macroglobules may be present
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14
Q

CALMS ddx

A
  • Pigmentary mosaicism - segmental pigmentation disorder, linear naevoid hyperpigmentation
  • Early naevus spilus –> before speckles appear
  • Becker melanosis
  • Mastocytoma
  • Mosaic neurofibromatosis
  • PIH
  • Lentigines, acquired melanocytic naevi
  • Flat congential melanocytic naevi
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15
Q

CALMS treatment

A
  • Never undergoes malignant change
  • Laser treatment - need to discuss risks, requires multiple treatments –> 12 CALMS treated with Q switched ruby laser –> 50% developed repigmentation within 6 months
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16
Q

Becker melanosis epidemiology

A
  • usually acquired
  • most often appear second and third decades of life
  • M>F
17
Q

Becker melanosis pathogenesis

A
  • Organoid hamartoma of ectodermally and mesodermally derived tissues
  • Increase in androgen receptors and possibly heightened sensitivity to androgens has been postulated
  • For congenital –> ?postzygotic mutations in beta-actin
18
Q

Becker melanosis clinical

A
  • second or third decade of life
  • sometimes following intense sun exposure
  • unilateral, usually upper quadrant of anterior or posterior chest but have been described elsewhere
  • ranges from a few centimetres to >15 cm
  • Can become slightly thickened with hypertrichosis
  • May enlarge for a year or 2, then stabilise
  • No malignancy change ever been reported
  • Associated hypoplastic changes: hypoplasia of the breast, areola, nipple, arm, scoliosus, etc
  • More likely to have associated changes in females
19
Q

Becker melanosis histo

A
  • Acanthosis, hyperkeratotisis +/- mild papillomatosis
  • Regular elongation of the rete ridges and hyperplasia of the pilosebaceous unit
  • Melanin content in keratinocytes increased
20
Q

Becker melanosis ddx

A

CALM, congenital melanocytic naevus, plexiform neurofibroma, congenital smooth muscle hamartoma

21
Q

Becker melanosis Rx

A
  • Electrolysis, waxing, camouflage makeup

- Laser treatments - Q switched ruby and NdYAD –> recurrence rates are high

Derm (57 decks)

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